As a dental specialty, orthodontics addresses and corrects problems with the alignment of the teeth. The word itself comes from the Greek word roots orthos, “straight or correct,” and -odont-, “tooth.” Problems like malocclusion (misaligned teeth), underbite, and overbite are more than just an aesthetic concern. They can actually cause further problems with the bones and muscles of the jaw, some of which can lead to craniofacial pain. They may also contribute to further enamel wear. For that reason, getting braces isn’t just something you do so you can have pretty teeth. It’s a medical concern.
Here are some of the most common problems that we diagnose and treat in our office. Some orthodontic problems are more common than others, but they can all be successfully treated.
Crowding is one of the most common reasons for people to get braces at a young age. When there isn’t enough room inside the mouth as the adult teeth erupt, they come in too close together. Because the teeth overlap, it’s difficult to clean them effectively, increasing the risk of tooth decay, dental caries, and gum disease.
Spacing, the opposite of crowding, occurs when the jaw itself is too large for the incoming adult teeth. Because the gums are more exposed, people with spacing are often at a higher risk of gum disease.
An underbite is when the lower jaw extends too far past the front teeth. This can cause chronic temporomandibular joint (TMJ) pain, excessive wear on the tooth enamel, and nighttime breathing difficulties.
The overbite is the underbite’s opposite, and it’s actually fairly common. The problem usually has a genetic origin. Decades ago, patients with an overbite were often stuck with the dreaded “headgear,” but nowadays, it’s not used as often. Treating an overbite involves promoting the growth of the lower jaw bones, and the best time to address this problem is around age 10-13.
When the upper teeth sit inside the lower teeth, it can interfere with the ability to chew food correctly. It can also wear down the teeth prematurely and cause headaches or neck pain. This condition is often treated during childhood with a palatal expander, a device that widens the upper jaw.
In an openbite, the upper and lower incisors don’t overlap. Instead, there’s a space between them when the jaw is closed. This problem needs to be addressed as early as possible.
In people with this condition, some of the teeth protrude outward past the normal point of contact with the lower teeth. This usually results from a person’s individual jaw position, which is determined by genetic factors. However, thumb sucking habits during childhood may also contribute.
An impacted tooth is a tooth that is stuck in the bony structure of the mouth. The canines are the second-most common teeth to become stuck, after third molars. Since canines are so important to biting and chewing, care is taken to restore them to their proper place.
You may suspect that your child has an impacted canine if a baby tooth fails to fall out on schedule, or if the adult tooth does not grow in. Around age seven, your general dentist will take an x-ray and count your child’s teeth. He or she can determine if all the adult teeth are present, whether or not there are extra (supernumary) teeth, or if there are other signs of crowding or blockages that may prevent adult teeth from erupting. It is important to make these diagnoses early, because if space is created for all adult teeth at the right time, they are more likely to grow into the correct position without the use of additional forces. The longer a tooth has to become stuck, the more intervention will be required to guide it into place.
If a dentist or dental specialist sees that your child is at risk for developing an impaction due to lack of space, an orthodontist can create the necessary space in the jaw so that teeth will grow into the dental arch on their own. If teeth have already become impacted, however, your orthodontist will refer you to an oral surgeon for a procedure known as an “expose and bond.” This simply means that the surgeon will remove the lingering baby tooth, uncover the impacted tooth, and bond an orthodontic bracket to it. The bracket will have a small gold chain attached to it which will attach at the other end to an orthodontic arch wire on the rest of the teeth. Under the care of an orthodontist, the impacted canine will gradually be moved into the correct position.
At the other end of the spectrum, if a fully grown adult is diagnosed with an impaction, that tooth is likely fused to the bone and will have to be completely removed. Other means such as crowns, bridges, or implants will be used in place of the missing tooth.
These problems are all fairly common, but fortunately, they can be fixed with proper early orthodontic treatment. Braces, palatal expanders, spacers, and other apparatus help move the teeth or jaw into the right positions. Not only does this improve the aesthetic appearance of the teeth, but it helps prevent further dental health problems later.